Conducting Patient Access in an Evolving Market

Drug Channels guest post. Mercalis' (formerly TrialCard) Bill Dupere and Eric Willis discuss the complexities of digital patient support program technologies and introduce Mercalis' (formerly TrialCard) integrated suite of solutions.

Patient support program (PSP) requirements must evolve to support the increased complexity and considerations of coverage requirements for new therapies. Historically we commonly think of “hubs” as the central coordinating center for all services for enrolled patients. While still true today, the modern approach to PSPs encompasses the digital source of truth for all data exchanges.

Market Situation

The core patient journey framework for most therapeutics includes workflows that support onboarding, coverage determination, barriers to access mitigation, determination of procurement option, financial navigation, and ongoing patient engagement.

Digital services within the PSP have become routine to include:

• Patient opt-ins, refill reminders, and outcomes surveys
• Portals to request specific services, submit documentation, and check case status
• Pharmacy benefit card finder technology
• Medical benefit eligibility transactions
• ePA and HCP support for submission
• eIncome soft credit check to assess financial eligibility for patient assistance programs

Furthermore, emerging technologies are of genuine interest to our life sciences clients, such as:

• Seamless enrollment via EHR integrations
• Real-time pharmacy benefits check
• Detailed PA requirements with more robust services for support
• Reliable and efficient medical benefit investigations
• Electronic prescription transfer capabilities

There are also diverse categories of vendor partners can deliver a part of the PSP ecosystem:

• Publicly traded drug wholesalers and distributors
• Large- and mid-sized PSP partners with broad services and technology platforms
• Emergent niche partners that typically focus on rare, orphan diseases
• Big SPs with putative pharma-focused PSP services
• Pharma-focused SPs or pharmacy networks that cobble together meaningful market share
• Technology partners with SaaS platforms that can add modules to deliver PSP components
• Core eServices technology suppliers that seek to add complementary PSP services.

The current PSP ecosystems typically require tokenization across a myriad of data types and sources. These include patient journey status, co-pay redemption, prescription dispense status, and inventory status, to name a few. Each is mapped to a common dictionary, provided via a secure file transfer protocol and subject to a QA/QC rules engine, which flags data records that do not conform. As such, data aggregator platforms are expected to remain the main conduit for data exchanges for the foreseeable future.

Market Need

More advanced life science clients constantly seek to integrate external features and functionality into their PSPs to improve overall efficiency and key stakeholder experiences. Paradoxically, there is the core market need. Simply said, our life science clients want to simplify access to the best-in-class technologies that, in turn, simplify access to therapy for their patients. Our clients have an appetite to work with fewer technology partners that have a robust platform, but seek a nimble and consultative approach whereby they can plug and play the necessary modules specific for their product and/or portfolio.

Client Objectives

• Our life sciences clients often seek partners for efficiency and accuracy that is often found across many external providers. This consideration leads to the following solution objectives:
• Integrate only the best-in-class external features and functionality
• Reduce the number of data interfaces and maintain data integrity
• Easily plug in new technologies and data sources
• Prioritize direct API integration when there is a specific need for real-time data
• Avoid disruptions to the core business

The Mercalis (formerly TrialCard) Approach

First, we identify and align with our clients for objectives such as:

Optimizing operations and data transparency across the entire patient journey
Use of best-in-class technologies via acquisition or through partnerships
Integrating the patient journey across many sources and/or touch-points
Requiring connectivity across multiple technology partners and data sources
Utilizing a combination of data file transfers, API connectivity, and reporting
Our experience suggests clients expect their chosen partner(s) to provide access to the core technology stack, define the road map, and employ dedicated resources to continually advance their ecosystem. This typically involves the following core workstreams, including:

• Flexible operating models catering to the product and/or therapeutic area
• Consistent workflows, personas and roles, implementation tools, and metrics as templates
• Partner as teammates, participating across functional areas within their company
• Define and introduce new technologies into their programs
• Respond quickly when they want to pilot other technologies of their own choosing

Our solution to these challenges has been to become an orchestrator in the concert of services the industry has to offer. We partner with industry-leading technology providers across the breadth of services that support the patient journey. We then connect those through our digital services to ensure cases and requests are routed to the service that best suits their specific needs. Facilitating this through single entry connection, we provide access to a network of services in an efficient and connected manner with utmost priority on unified data across the patient journey.

Bill Dupere
Vice President of Market Access Solutions & Practice Lead, Mercalis (formerly TrialCard)

Eric Willis

Vice President of Operations, Hub & Reimbursement Services, Mercalis (formerly TrialCard)